Welcome to Advanced Ankle & Foot

Upon your visit to Advanced Ankle and Foot, you will be welcomed by our friendly staff who will check you in with state of the art EMR Software. A visit to our practice is meant to be a positive and assuring experience as you will meet our highly qualified medical support staff and our exceptionally trained doctors. Our practice is one of open communication and understanding and should you have any questions during your treatment experience, please do not hesitate to ask!

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Before and After Gallery

Wound Care

Left Ankle Fracture Repair

Bunion and Hammertoe Surgery

Bilateral Pediatric Clubfoot Surgery

Medical Terminology for Ankle and Feet

People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following:

• Trauma, as in a foot or ankle sprain
• Chronic irritation from shoes or other footwear rubbing against the extra bone
• Excessive activity or overuse

Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.

Achilles tendon ruptures are most often seen in “weekend warriors” – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Inflammation is the body’s normal protective response to an injury, irritation, or surgery. This natural “defense” process brings increased blood flow to the area, resulting in an accumulation of fluid. As the body mounts this protective response, the symptoms of inflammation develop. These include:

• Swelling
• Pain
• Increased warmth and redness of the skin

Inflammation can be acute or chronic. When it is acute, it occurs as an immediate response to trauma (an injury or surgery), usually within two hours. When it is chronic, the inflammation reflects an ongoing response to a longer-term medical condition, such as arthritis.

Arthritis is a general term for a group of more than 100 diseases. “Arthritis” means “joint inflammation.” When it affects the ankle joint it can produce swelling and pain, and may eventually result in deformity, loss of joint function, and decreased ability to walk.

The most common form of ankle arthritis is osteoarthritis.

Similar symptoms may be caused by another form of arthritis, rheumatoid arthritis.

A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both.

Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Ankle pain is often due to an ankle sprain but can also be caused by ankle instability, arthritis, gout, tendonitis, fracture, nerve compression (tarsal tunnel syndrome), infection and poor structural alignment of the leg or foot. Ankle pain can be associated with swelling, stiffness, redness, and warmth in the involved area. The pain is often described as an intense dull ache that occurs upon weight bearing and ankle motion.

Initial treatment may consist of rest, ice, elevation, and immobilization, but may also include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, physical therapy, and cortisone injection. A foot and ankle surgeon can best determine the cause of the ankle pain and appropriate treatment options.

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as “arch pain.” Although this description is non-specific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as plantar fasciitis and is sometimes associated with a heel spur.

In most cases, arch pain develops from overuse, unsupportive shoes, weight gain, or acute injury. If arch pain persists beyond a few days, see a foot and ankle surgeon for treatment to prevent this condition from becoming worse.

Arch supports are devices that are placed into one’s shoes to support the arch and diminish or eliminate pain. A foot and ankle surgeon may provide advice on which type is best for your foot type, and you may be able to obtain arch supports from the doctor’s office. Arch supports can also be purchased without a prescription from drug, shoe, and sporting goods stores.

Athlete’s foot is a skin infection caused by fungus. A fungal infection may occur on any part of the body; on the foot it is called athlete’s foot, or tinea pedis. Fungus commonly attacks the feet because it thrives in a dark, moist, warm environment such as a shoe.

Fungal infections are more common in warm weather when feet tend to sweat more. Fungus thrives in damp areas such as swimming pools, showers, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is commonly found, thus the term “athlete’s foot.”

A black, purple, or brownish discoloration under or involving a toenail is frequently due to trauma to the toe nail, such as when something is dropped on the toe. The color results from a blood clot or bleeding under the nail, and may involve the entire nail or just a small portion of it. This can be very painful when the entire nail is involved, and may need medical attention to relieve the pressure caused by bleeding under the toenail.

Although it is very rare, a more serious cause of black toenails is malignant melanoma. Since early diagnosis and treatment of melanoma improves the chances for a good outcome, it is important that all black toenails be evaluated by a qualified foot and ankle surgeon to rule out this cause.

Bone healing is a complex process. Speed and success differ among individuals. The time required for bone healing can be affected by many factors, including the type of fracture and the patient’s age, underlying medical conditions, and nutritional status.

Bone generally takes 6 to 8 weeks to heal to a significant degree. In general, children’s bones heal faster than those of adults. The foot and ankle surgeon will determine when the patient is ready to bear weight on the area. This will depend on the location and severity of the fracture, the type of surgical procedure performed, and other considerations.

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Calcaneal apophysitis is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

Calcaneal apophysitis is also called Sever’s disease, although it is not a true “disease.” It is the most common cause of heel pain in children, and can occur in one or both feet.

Calf pain can result from many different causes. Sometimes something as simple as over-activity causes muscle strain in the calf. Or, dietary imbalances may cause cramping in the calf.

However, calf pain may be a symptom of more serious problems as well. Poor blood flow to the legs (peripheral vascular disease, or PVD) may cause cramping in the calf while walking or when sitting with the legs elevated. A blood clot in the calf (deep vein thrombosis or DVT), a very serious problem, also produces pain in the c

A callus is a thickened area of skin on the foot caused by pressure and repeated rubbing, such as from a shoe or sock. The rubbing causes the skin to produce a layer of protective skin (a callus). Calluses vary in size, and can become painful.

There are a number of treatments for painful calluses. People who have calluses are cautioned against performing “bathroom surgery,” as this can lead to cuts and infection. A foot and ankle surgeon can evaluate the cause of the calluses and recommend the treatment most appropriate for your condition. However, if the underlying cause of the callus is not treated or removed, the callus may return.

Ligaments surrounding the joint at the base of the second toe form a “capsule,” which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed.

Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis—also referred to as predislocation syndrome—is a common condition that can occur at any age.

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.

Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the “giving way” occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability.

Cold feet are most commonly a result of medical conditions that cause poor blood flow in the legs or feet, such as peripheral vascular disease (PVD), a blockage or narrowing of the arteries, Raynauds’s phenomenon (cold sensitivity which causes a spasm of the blood vessels), and heart disease. Some medications which cause constriction of blood vessels can also lead to cold feet or limbs. Beta blockers for high blood pressure, ergotamine medications for migraine headaches, and cold medications that contain pseudoephedrine may all cause this problem.

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground.

Contact dermatitis of the foot is an inflammation of the skin in response to an irritant. This irritant is something with which the foot has come into contact, such as materials and chemicals with which shoes are made, poison ivy or harsh chemicals.

When the skin of the foot comes into contact with the substance, an allergic response is initiated. Symptoms, including redness, itchiness, and small blisters, usually occur within 24 hours of exposure to the irritant. The symptoms should be evaluated by a foot and ankle surgeon for proper diagnosis and treatment.

A “corn” is a small circular thickened lesion in the skin of the foot. It usually forms due to repeated pressure on the skin, such as the rubbing of a shoe. The name “corn” comes from its resemblance to a kernel of corn. A corn is different from a callus in that it has a central core of hard material.

People with foot deformities, such as hammertoes, often suffer from corns because the tops of the bent toes rub against the tops of shoes.

There are many potential causes of “cracked heels.” Dry skin (xerosis) is common and can get worse with wearing open-back shoes, increased weight, or increased friction from the back of shoes. Dry cracking skin can also be a subtle sign of more significant problems, such as diabetes or loss of nerve function (autonomic neuropathy).

Heels should be kept well moisturized with a cream to help reduce the cracking. If an open sore is noted, make an appointment with a foot and ankle surgeon for evaluation and treatment.

Custom orthotics are medical devices prescribed by a foot and ankle surgeon. These shoe inserts, which support and align the foot and lower extremities, are formed by making a plaster mold of the foot.

The blood supply of the leg is transported by arteries and veins. The arteries carry blood from the heart to the limbs; veins carry blood back to the heart. The leg contains superficial veins, which are close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or thigh), they can also develop in other parts of the body.

People with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.

Having diabetes increases the risk of developing a wide range of foot problems. Furthermore, with diabetes, small foot problems can turn into serious complications.

Diabetes can be dangerous to your feet – even a small cut can produce serious consequences. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice a foreign object in your shoe. As a result you could develop a blister or a sore. This could lead to an infection or a non-healing wound that could put you at risk for an amputation.

Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.

Shoes for diabetic patients are made of special protective inserts and soft shoe materials to accommodate for conditions such as neuropathy (numb feet), poor circulation, and foot deformities (bunions, hammertoes, etc.). The shoes decrease the chance of foot sores (ulcers) which can be caused by friction and pressure. This may lead to infection, gangrene, or even amputation.

The foot and ankle surgeon may measure the diabetic patient’s foot and have the shoes made at a specialty laboratory. In some cases he/she will give the patient a prescription to have the shoes custom-made.

Eczema is a general term that includes many conditions that cause inflammation of the skin. The symptoms of eczema vary, but generally appear as dry, red, extremely itchy patches of skin. Small blisters may sometimes form.

Eczema can occur on any part of the body including the foot. It occurs in both children and adults and is not contagious. There is no known cause for eczema, but it often affects people with a family history of allergies.

Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.

People with equinus develop ways to “compensate” for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by “toe walking,” while a smaller number take steps by bending abnormally at the hip or knee.

There are 26 bones in the human foot. Some people have “extra bones” (accessory ossicles) which are usually congenital (present at birth) but may also be due to previous trauma. These extra bones, which can occur with any bone in the foot, can be painless (asymptomatic) and are only noticed when the foot is x-rayed. Sometimes they are painful and cause significant discomfort. This pain can usually be treated by the foot and ankle surgeon using a variety of non-surgical measures, although sometimes the extra bones may need to be surgically removed.

“Fallen arches” is a common term used to describe a flatfoot condition that develops during adulthood. This should not be confused with other causes of flatfoot that may develop during childhood or adolescence.

Most cases of “fallen arches” develop when the main arch-supporting tendon (the posterior tibial tendon) becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and secondary symptoms start to appear.

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Arthritis is a general term for a group of more than 100 diseases. “Arthritis” means “joint inflammation.” When it affects joints of the foot it can produce swelling and pain, and may eventually result in deformity, loss of joint function, and decreased ability to walk.

Foot bumps are boney projections that can occur anywhere on the foot. They can be a natural enlargement of a foot bone, or they can be an extra bone. They can be asymptomatic (without pain) or symptomatic (painful). If they are not painful, they can usually be accommodated by shoe gear. Painful foot bumps can be treated by the foot and ankle surgeon using a variety of conservative treatments. In some cases, surgery may be necessary.

There are 26 bones in the foot. These bones support our weight and allow us to walk and run. Certain activities or injuries can cause a fracture, or “break,” in one or more of these bones. Pain, swelling, redness, and even bruising are signs of a possible fracture. Fractures of the foot can be diagnosed by x-rays or other studies. A foot and ankle surgeon can determine the best treatment course. Often rest, icing, and immobilization are the treatments; however surgery is sometimes necessary to repair the fracture.

Foot lumps are soft tissue masses (not bone) that can occur anywhere on the foot. They can be caused by soft tissue swelling, sacs of fluid, fatty tissue, and nerve, vessel or muscle enlargements. Foot lumps may be without pain (asymptomatic) or they can cause pain and affect the function of the foot. Painful foot lumps can be treated by the foot and ankle surgeon using a variety of conservative treatments. In some cases, surgery may be necessary.

Foot odor is a common condition in children and adults who wear shoes on a daily basis. People with smelly feet may also suffer from sweaty feet. Most people with this condition will have sweaty and smelly feet year round, not just in the hot summer months. The odor is produced by bacteria and/or fungus that grows in the shoes and attaches to the skin. Some bacteria actually eat away the top layer of the skin, producing a foul odor.

Hygiene is very important to help prevent smelly feet. Feet should be washed daily with soap and water and clean dry socks worn. Some synthetic materials used in shoes, when mixed with sweat and bacteria, can produce smelly feet.

The foot and ankle surgeon will recommend one of a variety of treatments for this condition.

A rash on the foot can have a variety of causes. It may be a form of eczema, which is usually very itchy. It also may be an allergic reaction to something with which your feet have come into contact, such as materials in your shoe or poison ivy. Another common reason for a foot rash is athlete’s foot, which is caused by a fungal infection. Only by having the rash examined will you be able to get a precise diagnosis. A foot and ankle surgeon will determine the cause of your rash and provide appropriate treatment.

The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.

The calcaneus is often compared to a hard boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.

Fractures (breaks) are common in the fifth metatarsal – the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:

• Avulsion fracture
In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.

• Jones fracture
Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.

A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin.

GanglionGanglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot – usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger, and may even disappear completely, only to return later.

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. ‘Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.

This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoe2Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

The foot contains 26 bones and more than 30 joints. Many people experience pain involving one or more of these joints. The pain may be accompanied by swelling, tenderness, stiffness, redness, bruising and/or increased warmth over the affected joints.

Joint pain may be caused by trauma, infection, inflammation, arthritis, bursitis, gout, or structural foot problems. It is initially treated with rest, elevation and limitation of walking/weight bearing on the painful foot. Use of non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and ice can help to reduce local inflammation and pain. Custom orothotic devices may also be prescribed to support the foot and reduce pain.

A foot and ankle surgeon can best determine the cause of joint pain and recommend the appropriate treatment.

The foot contains 26 bones and more than 30 joints. The body’s natural response to any type of joint injury is to increase blood flow to the affected area. This results in an accumulation of fluid in the tissues in and around the joint, resulting in swelling. Depending on the cause of the injury, joint swelling may be accompanied by stiffness, redness, warmth and pain.

Joint swelling may also result from inflammatory, degenerative, traumatic, infective, or crystal-forming joint diseases, such as gout. If joint swelling persists, a foot and ankle surgeon can best determine the cause and recommend the appropriate treatment.

The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint.

Melanoma is a cancer that begins in the cells of the skin that produce pigmentation (coloration). It is also called malignant melanoma because it spreads to other areas of the body as it grows beneath the surface of the skin. Unlike many other types of cancer, melanoma strikes people of all age groups, even the young.

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

A fungus is an organism that lives in warm moist areas. Fungus of the toenails is a common problem that can affect people of all ages, although it most commonly affects individuals who are older.

Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.

Many people have difficulty with their toenails and need assistance in caring for them. A foot and ankle surgeon can diagnose the cause of toenail problems and recommend treatments.

Often, people don’t know they have an os trigonum if it hasn’t caused any problems. However, some people with this extra bone develop a painful condition known as os trigonum syndrome.

Os trigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities.

Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Some people refer to osteoarthritis simply as arthritis, even though there are many different types of arthritis.

Flatfoot is common in both children and adults. When this deformity occurs in children, it is referred to as “pediatric flatfoot.” Although there are various forms of flatfoot, they all share one characteristic – partial or total collapse of the arch.

Pediatric flatfoot can be classified as symptomatic or asymptomatic. Symptomatic flatfeet exhibit symptoms such as pain and limitation of activity, while asymptomatic flatfeet show no symptoms. These classifications can assist your foot and ankle surgeon in determining an appropriate treatment plan.

Commonly referred to as “poor circulation,” Peripheral Arterial Disease (P.A.D.) is the restriction of blood flow in the arteries of the leg. When arteries become narrowed by plaque (the accumulation of cholesterol and other materials on the walls of the arteries), the oxygen-rich blood flowing through the arteries cannot reach the legs and feet.

The presence of P.A.D. may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke, or the heart, causing a heart attack.

A tendon is a band of tissue that connects a muscle to a bone. The two peroneal tendons in the foot run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch.

The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sp

A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (non-malignant), and usually will not go away or get smaller without treatment.

Definitive causes for this condition have not been clearly identified.

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.

Puncture wounds are not the same as cuts. A puncture wound has a small entry hole caused by a pointed object, such as a nail that you’ve stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury.

Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop

Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints.

RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.

A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.

Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

“Shin splints” is a term to describe pain and swelling in the front of the lower legs. The pain usually appears after and is aggravated by repetitive activities such as running or walking. Contributing causes are flat feet, calf tightness, improper training techniques, worn out or improper shoes/sneakers, as well as running or walking on uneven surfaces. The inflammation in the shin results from the repeated pull of a muscle in the leg from the shin bone (tibia).

This condition usually occurs bilaterally (both legs) and can be alleviated by rest, use of non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, icing, a change in training habits, stretching exercises, and properly fitted shoes. A foot and ankle surgeon can treat the condition, recommend proper shoe gear, and evaluate whether orthotics are needed. If not treated, shin splints may eventually result in a stress fracture of the shin bone.

Arch supports and shoe inserts are devices that are placed inside of shoes to support and align the foot and lower extremities (knees, hips, and lower back), thus preventing the progression of a foot deformity, improving the function of the foot, and diminishing or eliminating pain.

These devices can range from generic over-the-counter inserts to prescription devices custom made for the individual’s foot and/or foot problem.

Stress fractures are tiny, hairline breaks that can occur in the bones of the foot. They can be caused by overtraining or overuse, improper training habits or surfaces, improper shoes, flatfoot or other foot deformities, and even osteoporosis. These tiny breaks in the bones of the feet can lead to a complete break if left untreated.

Pain, swelling, redness, and possibly bruising can be signs of a stress fracture. The fracture can occur almost anywhere in the foot. X-rays and other studies are used to diagnose the stress fracture. A foot and ankle surgeon should be seen as early as possible to start treatment and possibly shorten the recovery time.

Possible treatments include rest and possible immobilization of the foot. In some cases, surgery may be required to stabilize the stress fracture or to repair a stress fracture that has progressed to a fracture.

The number of sweat glands is most dense at the feet and hands. Sweaty feet are a common disorder in which the sweat glands of the feet produce excessive sweat. Persons with this condition usually have a genetic predisposition or are under stress, which activates the brain to produce more sweat to keep the body cool.

Athlete’s foot or smelly feet may accompany sweaty feet. The foot and ankle surgeon can recommend one of a variety of treatments for this condition.

Swelling of the ankles may be due to many factors, including trauma, infection, tumor, varicose veins, improper function of the lymphatic system, poor circulation, hypertension, and congestive heart failure, to name a few.

The foot and ankle surgeon will recommend treatment based on examination and diagnosis of the cause of the swelling.

Swelling of the feet may be due to many factors, including trauma, infection, tumor, varicose veins, improper function of the lymphatic system, poor circulation, hypertension, and congestive heart failure, to name a few.

The foot and ankle surgeon will recommend treatment based on examination and diagnosis of the cause of the swelling.

Tailor’s bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The prominence that characterizes a tailor’s bunion occurs at the metatarsal “head,” located at the far end of the bone where it meets the toe.

Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.

The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone.

The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage.

Talar dome lesions are usually caused by an injury, such as an ankle sprain. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. Sometimes a broken piece of the damaged cartilage and bone will “float” in the ankle.

A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet.

The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.

Toenails will often become thick as an individual grows older. Thickening may also occur as a result of trauma to the toenail, such as when it repeatedly hits the end of a shoe that is too short. Sometimes when something is dropped on the toenail, the nail will fall off. When a new toenail grows back it will often be thicker than it was previously.

Thick toenails can also be seen in individuals with nail fungus (onychomycosis), psoriasis, and hypothyroidism. Those who have problems with the thickness of their toenails should consult a foot and ankle surgeon for proper diagnosis and treatment.

“Tingly feet” can be a sign of nerve loss. The nerves in the feet come from the lower back. Pressure or chemical change in the nerve can cause a tingling sensation in the feet. Any sensation that is out of the ordinary can be an early sign of neurologic or vascular problems. In addition to tingling, feet may feel numb or feel like they are “falling asleep.” There may also be a burning sensation in the feet.

Diabetes is one of the most common medical conditions with which “tingly feet” can be associated. A thorough evaluation by a foot and ankle surgeon is advised to determine the cause of “tingly feet.”

The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in the foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist.

A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

Turf toe is a sprain of the big toe joint resulting from injury during sports activities. The injury usually results from excessive upward bending of the big toe joint. The condition can be caused from either jamming the toe, or repetitive injury when pushing off repeatedly when running or jumping.

Although this injury is most commonly reported in football players, participants in soccer, basketball, wrestling, gymnastics and dance also are at risk.

Varicose veins are usually due to improperly functioning valves within the veins. The veins typically appear prominent or look “raised.”

The condition can cause swelling of the legs, ankles, and feet. The skin may become discolored due to leakage of blood into the surrounding tissues, and ulcers may form on the skin. The foot and ankle surgeon may advise use of compression stockings or other treatments.

Weak ankles may be a result of previous ankle injuries, but in some cases they are a congenital (at birth) condition. The ankles are sore, and “give way” easily while standing, walking, or doing other activities.

When an ankle is injured, it may take a few weeks to many months to fully heal. Often, the injured ankle remains weaker and less stable than the uninjured one. A foot and ankle surgeon can assess ankle stability and may obtain medical imaging studies to evaluate the ankle for further damage.

Treatment for weak ankles usually includes physical therapy and bracing. Surgery may be recommended depending on the degree of instability and the response to non-surgical approaches.

Trauma, such as when an object is dropped on a toenail, often causes bleeding under the nail because of blood vessels being broken. This would cause a black toenail. If the trauma does not cause broken blood vessels, a white spot may appear under the nail. The spot will slowly grow out with the normal growth of the toenail.

The most common cause of yellow discoloration in the toenails is a fungal infection. The fungus often develops underneath the nail, resulting in it becoming thick, raised, and yellow in color.

Other potential causes for yellow discoloration of the nail include diabetes mellitus and lymphedema (chronic leg swelling). Yellow staining of the nails can also occur in individuals who use nail polish. A stained nail may take several months to grow out.